A case of jejunal adenocarcinoma diagnosed by preoperative double balloon enteroscopy

Abstract

Despite a thorough history, physical examination, and complete diagnostic workup, the correct diagnosis of small-intestinal malignancy is established preoperatively in only 50% of cases; an exploratory laparotomy is often required. However, recent advances in endoscopic technologies, such as double-balloon enteroscopy (DBE), have been shown to facilitate the preoperative diagnosis of these tumors. Confirmation of malignancy using DBE in equivocal cases may greatly increase both patients' acceptance of surgery and the confidence of the physician planning a surgical resection. We describe herein the case of a 53-year-old woman with a stage I jejunal adenocarcinoma that was diagnosed by DBE and treated by laparoscopic jejunectomy. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0) without muscularis propria invasion, lymphovascular invasion, or lymph-node metastasis.

Keywords: Adenocarcinoma; Double ballon enteroscopy; Jejunum.

Fig. 1

Computed tomography of the abdomen revealing significant thickening (arrow) of the jejunal wall.

Fig. 2

(A) Double-balloon enteroscopy revealed a circumferential infiltrative mass in the proximal jejunum. (B) Note the submucosal India ink injection that was used to mark the tumor location to facilitate subsequent laparoscopic surgery.

Fig. 3

Macroscopic examination of the lesion revealed it to be a circumferential, infiltrative tumor measuring 45×25×8 mm.

Fig. 4

Histological examination confirmed that the tumor was a moderately differentiated adenocarcinoma, without invasion through the muscularis propria (H&E stain, ×2). There was also no lymphovascular invasion or lymph-node metastasis.